Abstract 12P
Background
Classification of lymph node metastases according to the size into macrometastases >2 mm (MAC), micrometastases 0.2 - 2 mm (MIC) and isolated tumor cells <0.2 mm (ITC) was adopted from breast cancer to other tumour types. In cervical cancer, MAC is well established as one of the main prognostic factors, indicating adjuvant treatment after primary surgery, while the impact of MIC and ITC has been subject of controversy. The aim of this study was to identify the cut-off for the minimal size of metastasis which is not associated with negative prognosis.
Methods
Data of 967 cervical cancer patients, T1a1 L1 - T2b stages, after primary surgical treatment with curative intent, including SLN biopsy followed by pathological ultrastaging, were obtained from the SCANN (Surveillance in Cervical CANcer) study. The size of SLN metastasis was considered a continuous variable, and multiple testing was performed for cut-offs ranging from 0.01 to 1.0 mm in 0.01 mm intervals. DFS in each subgroup was compared with the N0 cohort and each N1 group (> cut-off) using Log rank test.
Results
Positive SLN was found in 172 (18%) patients. Based on traditional classification, MAC, MIC, and ITC was the largest metastasis in 79 (8%), 54 (5%), and 39 (4%) cases. Patients with MAC and MIC had significantly shorter DFS than those with N0 disease (HR 2.20, p=0.003; HR 2.87, p < 0.001) with no difference between them (p=0.484). When subgroups were analysed using cut-off method, all patients with metastases ≥0.4 mm had significantly shorter DFS when compared to the N0 (HR = 2.311; p=0.04). The significance of metastases <0.4 mm could not be assessed due to the lack of power (<80%).
Conclusions
Lymph node metastases in patients with cervical cancer are associated with significantly negative impact on DFS irrespective of their size. No cut-off value for a minimal size of metastasis without negative prognostic impact can be found. Therefore, traditional classification to MAC/MIC/ITC should not be adopted in cervical cancer and the management should be uniform irrespective of the size of metastasis.
Legal entity responsible for the study
The authors.
Funding
Charles University, Prague (UNCE 204065 and PROGRES Q28/LF1).
Disclosure
All authors have declared no conflicts of interest.